ISSN: 2469-5734 Petrikas et al. Int J Oral Dent Health 2019, 5:086 DOI: 10.23937/2469-5734/1510086 Volume 5 | Issue 2 International Journal of Open Access Oral and Dental Health REVIEW ARTICLE Classification of the Methods of Local Anesthesia and Special Features of Vascular-Diffuse Injection Petrikas AZ1*, Medvedev DV2, Yakupova LA2, Efimova OE2, Chestnyh EV2, Kulikova KV3 and Sazonova KA4 1Professor, Cathedra of Therapeutic Stomatology, Tver State Medical University, Russia 2Professor Assistant, Cathedra of Therapeutic Stomatology, Tver State Medical University, Russia 3 Check for Graduate Student, Cathedra of Therapeutic Stomatology, Tver State Medical University, Russia updates 4Student, Tver State Medical University, Russia *Corresponding author: Arnold Petrikas, DMSc, DMD, PhD, Professor, Cathedra of Therapeutic Stomatology, Tver State Medical University, 170100, Tver, Sovetskaya, Str 4, Russia Table 1: Modified classification of the methods of local Abstract anesthesia. The main feature of modern injection methods of dental anesthesia is in the local venous spreading of the Local anesthesia anesthetic in the near-toothed spongy substance of Diffuse Vascular-diffuse the bone and dental pulp. The vascular mechanism is Topical Intraosseous controlled by the epinephrine anesthetic solution and patient vegetal system. Spongy dental anesthesia is Conductive Intraligamentary universal, highly effective, relatively safe, easy to implement Infiltrative Intraseptal and increasingly widespread. Classification proposed by us is the division of injection methods of anesthesia into Intrapulparial traditional diffuse: Infiltrative and conductive, and diffuse- vascular: Intraosseous, intraligamentary, intraseptal and is to divide the methods of anesthesia into diffuse and intrapulparial. vascular-diffuse [5-7] (Table 1). Keywords Types of spongy anesthesia significantly differ from Dental anesthesia, Intravascular injection, Aspiration, In- traditional diffuse infiltration and conduction injec- traosseous anesthesia, Intraligamentous anesthesia, Epi- tions. All three types of spongy anesthesia spread in nephrine the spongy bone, i.e. they are both intraosseous and venous. Main types of spongy anesthesia are presented Introduction in Figure 1 [6,7]. Earlier Petrikas AZ with assistants Yakupovа LA, The effect of spongy anesthesia is given by the Medvedev DV, Efimova OE in their studies established following mechanism (Figure 2). Using an injector with the vascular mechanism as a leading component of a needle, the local anesthetic solution is supplied to the spongy injection [1-4]. Considering the high efficiency, external target on the oral mucosa which determines relative safety, versatility, ease of implementation and the name of the injection. The anesthetic solution the increasing prevalence in the world with no serious delivery under pressure against the blood flow is complications, a modification of local anesthesia blocked by α-adrenoreceptors of arterioles which close methods which has not changed significantly since 19th the depot. The spongy intraosseous depot in the area of ​​ century was proposed. The essence of this modification the internal target provides an effective concentration Citation: Petrikas AZ, Medvedev DV, Yakupova LA, Efimova OE, Chestnyh EV, et al. (2019) Classifica- tion of the Methods of Local Anesthesia and Special Features of Vascular-Diffuse Injection. Int J Oral Dent Health 5:086. doi.org/10.23937/2469-5734/1510086 Accepted: April 17, 2019: Published: April 19, 2019 Copyright: © 2019 Petrikas AZ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Petrikas et al. Int J Oral Dent Health 2019, 5:086 • Page 1 of 5 • DOI: 10.23937/2469-5734/1510086 ISSN: 2469-5734 Figure 1: Types of spongy anesthesia: А) Special perforation of cortical plate, for example by a bur (intraosseous); B) Perforation of septa of cortical plate with manual needle movement (intraseptal); C) Insertion of a needle manually into periodontal ligament (intraligamentary). Figure 2: The establishment of an anesthetic depot during spongy anesthesia. of the drug and the required volume. The volume dose Point 2 of anesthetic is very important for the fast wetting of The depot of the spongy spreading covers the peri- the required number of nerve receptors and Ranvier’s odont and pulp-a pulpo-periodontal complex of one or interceptions located near the venous vessels [5-7]. more often several teeth. On the average, intraosseous Special Features anesthesia blocks 2, 3 teeth [2], intraligamentary-3, 6 teeth [3]; intraseptal-2, 6 [4]. The number of blocked Point 1 teeth depends on the dose of anesthetic. Mono tooth Epinephrine should be present in local anesthetic intraligamentary anesthesia is a common misconcep- solution. The need of epinephrine was proved by the tion. It is characteristic for the company Mielstone experience of using intraligamentary and infiltrative which gave the name to its advertised computer injec- anesthesia with mepivacaine without epinephrine in 65 tor: STA-Single Tooth Anesthesia, considering one tooth healthy volunteers [5,7]. anesthesia. Epinephrine did not close the depot of injectable Point 3 flow of mepivacaine through the veins after spongy The effect/time chart for spongy anesthesia is anesthesia with positive aspiration. Thus, mepivacaine fundamentally differ from the classical, for example, did not create a depot and proceeded past the needle- infiltrative (Figure 3). The essence of the differences probed area. Petrikas et al. Int J Oral Dent Health 2019, 5:086 • Page 2 of 5 • DOI: 10.23937/2469-5734/1510086 ISSN: 2469-5734 mkA 120 P < 0.05 100 INF ILA 80 60 40 20 0 0 min 2 min 5 min 10 min 15 min 20 min Figure 3: Chart: Effect/time after infiltrative and intraligamentary anesthesia of mepivacaine without adrenaline over the pain limit to an alternating electrical amperage of an intact upper lateral incisor in healthy volunteers [8]. Figure 4: The effect of spongy anesthesia begins almost immediately reaching a maximum level and also end abruptly. is that the effect from all types of spongy anesthesia spongy injections for the fast onset of anesthesia and its begins almost 1) Immediately under the needle; 2) With maximum depth (Figure 4). a maximum depth; 3) End abruptly according to the “all or nothing” law. These are the main clinical differences Point 5 from infiltration anesthesia. Positive aspiration in all spongy anesthesia occurs in approximately 90% of cases [11]. With intraligamental Point 4 and intraseptal injection, positive aspiration was ob- The dose of spongy anesthesia is approximately served in the form of a thin stream with a frequency 2 times less than infiltrative anesthesia. This reduces of 34/36/94.4% and 68/76 /89.4%, respectively. With the possibility of toxic reactions, but not psychogenic. intraosseous aspiration, the frequency of positive aspi- Diffuse anesthesia expends its material on overcoming rations was observed in 68/76/89.4%. This data demon- of tissue surrounding the tooth. This is clearly seen strates the venous mechanism of spongy injections and while the lower molars anesthesia. Spongy anesthesia contradict the books of Malamed [13-15], where all ad- became an alternative for mandibular injections [8- ditional anesthesia is represented by a zero frequency 12]. Thus, the efficiency of spongy anesthesia greatly of positive aspirations. exceeds traditional injections. Clinicians appreciate Petrikas et al. Int J Oral Dent Health 2019, 5:086 • Page 3 of 5 • DOI: 10.23937/2469-5734/1510086 ISSN: 2469-5734 Figure 5: The spreading of staining agent in the pulp of the tooth after intraseptal anesthesia (corpse of 36 years woman) [8]. esthetic it is necessary to hold it there for the creation depot for a certain time-about 40 seconds [16]. Using of photoplethysmography proved that blood flow stops in the pulp after an intraligamentary injection of lidocaine with epinephrine for 15 minutes [3,16]. Point 8 A quality feature of spongy anesthesia in contrast to classical, for example, mandibular is the absence of paresthesia of facial tissues: Lips, cheeks, tongue, face skin. Point 9 Using intraligamentary anesthesia bacteremia was observed in 50-97%, and using infiltrative anesthe- sia-16% [17]. Walton R, et al. [18] clarify that bactere- mia occurs with intraligamentary injections not more often than with other dental procedures. Heizmann R, et al. [19] did not observe bacteremia for more than 10 years using the intraligamentary anesthesia in the clin- ic. Zugal W [20] writes about the same over a five-year period. Bacteremia with intraligamentary anesthesia Figure 6: The spreading of mercury in the corpse after is comparable to the frequency observed during tartar intraseptal injection between 44 and 43. removal and curettage of the gum pockets. It is tempo- rary. Antiseptic treatment of the gingival sulcus reduces Point 6 bacteremia from 61% to 30% [21]. The skepticism of the The histological picture after intraseptal injection of injection is an important ethical problem of spongy an- the dye (carcass) on the cadaver clearly demonstrates esthesia. its venous spreading in the dental pulp because of the Point 10 good vascular permeability of the carcass compared to mercury (Figure 5 and Figure 6). With spongy injections The vascular spreading of epinephrine with spongy of mercury and dyes